Update on Transplant

Update on Transplant


Paul has been out of the hospital for over two weeks and has not needed a transfusion during that time – and that is the longest he has gone since March.  His white blood cells remain within the normal range.  His red blood cell and platelet counts are still low, but holding steady.  The doctors recently biopsied his bone marrow and confirmed that the transplanted cells are, indeed, producing blood.

It is a slow process to rebuild one’s bone marrow, but Paul seems to be on course to do that.

Ethics and Markets – Stem Cells

Ethics and Markets – Stem Cells


A couple of recent developments have motivated me to make a few comments beyond the opinions I sometimes interject into these posts.

The first is that a friend recently asked about the ethics of stem cell transplants.  Apparently the phrase “stem cell transplant” has become a kind of buzz word that unnecessarily causes emotional reactions.  While there are serious ethical issues surrounding the use of embryonic stem cells for research and medical procedures, none of those issues relate to the use of stem cells such as I donated for transplant to my brother.  In its statement “On Embryonic Stem Cell Research,” the United States Conference of Catholic Bishops very plainly stated:  “Stem cells from adult tissues, umbilical cord blood, and placenta (often loosely called ‘adult stem cells’) can be obtained without harm to the donor and without any ethical problem, and these have already demonstrated great medical promise.”

Another ethical issue is whether donors should be paid to donate.  Currently such payment is illegal under the National Organ Transplant Act (“NOTA”).  In October of 2009, a lawsuit – Flynn v. Holder, CV 09 0772 – was filed in federal court in California challenging the constitutionality of the ban on such payments.  The district court recently dismissed that case.  The dismissal has been appealed, but for now the ban on payment remains the law.

There is a recent article in the Southern California Law Review which may be read at http://lawweb.usc.edu/why/students/orgs/lawreview/documents/SCalLRev84_Young.pdf

The author, a brand new 2011 graduate of the University of Southern California Law School, argues that the ban on payments should be lifted because it would offer greater incentives for people to donate and increase the possibility that those needing transplants  would find a suitable donor.

It seems, at least in my opinion,  that the underlying issue is not really an ethical one or the concern for access to treatment.  Rather, it is what kind of market can be created for stem cells and who is going to profit from their use.  At present, I am in favor of the prohibition on compensation under NOTA which keeps the US in conformity with international standards.

That prohibition does not mean that there is not an active market in some types of stem cells, however.  There are currently more than 150 companies involved in some manner in the stem cell market, some of which are publicly traded, and  which offer a wide variety on ways to enter the stem cell market.  Aastrom Biosciences, for instance is developing technology intended to help umbilical cord and bone marrow stem cells to replicate.  Some companies like Geron have been working for several years developing therapies based on the controversial use of embryonic stem cells.  Others, like Pluristem Therapeutics, Inc., have made advances utilizing less controversial placental stem cells.

I am not in any way recommending any kind of investment in any of these companies (though, in the interest of fair disclosure, I want to say that I own a small amount of stock in Pluristem).  I merely want to point out, with examples, that there is already an active market in stem cells.  Payment to stem cell donors, if permitted, would eventually increase the scope of that market.  However, unless such payment becomes an accepted international practice, it seems a bad idea.


Houston: We Have Engraftment

Houston:  We Have Engraftment


I have been waiting for a few days to post this.  As you may have noticed from prior posts, I like to at least try to understand some of the science behind the stem cell or bone marrow transplant process.  I believe that it has been established scientifically that if you write or speak about something good too soon it could jinx anyone involved in the process.  As a student of science, I did not want that to happen.

I mentioned in an earlier post (http://ralstoncreekreview.com/?p=53) that after the transplant has been done, the next major goal is what is known as “engraftment.”  Engraftment occurs when the donor stem cells (the ones that were taken from me) attach to the recipient’s (Paul’s) bone marrow so they may begin producing blood cells.  It cannot be directly observed when that occurs.  Rather, the doctors have been checking Paul’s blood each day, especially watching the white blood cell count.  White cells have such a short life span that any he had before the transplant would have died by now (even if they had survived the chemotherapy).  An increase in the white cells would indicate that they are being produced by stem cells.

Paul’s white blood cell level fell to nearly, but not quite, zero and then stayed at less than 5% the normal level for several days.  A little over a week ago, the white cell count began to creep slowly higher.  Within a few days, the daily increases became greater until yesterday when the count was within the normal range.  It was still in the normal range – even higher than yesterday – this morning, making it apparent that the engraftment has occurred. 

Since Paul is making white blood cells now, his immune system should be able to handle the dangers of the normal world, so he was released from the hospital this afternoon, nearly a month after he entered it the week following Labor Day!

This is significant, but it is only one of a number of steps that must occur if the transplant is to cure the myelofibrosis.  Although the white blood cell level is now acceptable, he has not yet begun making enough red cells.  In fact, he required a transfusion before leaving the hospital today.  His platelet count also remains low.  Therefore, the doctors are working to stimulate the production of those other cells. 

He has to stay in Houston for several weeks yet, and will be returning to the hospital for testing and treatment each day.  Next week they will perform another bone marrow biopsy to get a better look at the progress that has been made.  Still, the engraftment seems to have taken place.  This is very good news and a major step in the right direction.

Again, all of the prayers and Reiki and kind thoughts offered by so many people are sincerely appreciated.